Read before the Medical and Chirurgical Faculty of Maryland, 
Annual Session, April, 1874. 
Little People as Aids to ] Diapsis and Treatment. 
By J. R. UHLER, M. D. 
Modern Surgery is chiefly indebted for its exactness to the 
many aids that have been furnished to diagnosis, and it is principally 
through these that rational knowledge of disease has arisen and 
the vast progress of the last few years been attained. It is there- 
fore with no apologies that I offer a simple, yet hitherto neglected 
or unknown method for dealing with affections that cannot readily 
be gotten at otherwise. I refer more particularly to certain obscure 
diseases of the intestines and abdominal cavity, including intussus- 
ception concretions, malignant disease, atrophy or hypertrophy of 
the liver, spleen, pancreas, kidney, and tumors in the pelvic or 
abdominal cavity, such as fibroids, ovarian tumors, aneurisms, etc., 
where it is essential not only to ascertain their existence, but also 
if there be adhesions. In very large prostate also, where there is 
the greatest difficulty in introducing the catheter,* where stone is 
suspected but not positively proved by other means, such as the 
sound, lithotrite, endoscope, etc., or where substances have been 
swallowed that must be removed from the stomach by operation, 
this method offers a chancef for doing something successfully where 
heretofore we were almost hopeless. In the introduction of the 
rectal tube for the purpose of inflation or injection into the intes- 
tines,. or removing impacted faeces from the colon abovej the sig- 
moid flexure, there is nothing that can compare with it for cer- 
tainty. || At the same time we do not wish to urge its use to the 
exclusion of other well-tried methods,§ but to place in our hands 
*The bladder may be brought toward the pubis or perineum, so as to shorten th e 
distance to be traversed by the catheter, sound, or lithotrite, when the hand is 
small enough to be passed well in the rectum. 
+ 1 say chance, for we cannot succeed unless the stomach be reachable through its 
walls and the walls of the colon. 
£Our usual means are generally effective below that point. 
1 It may be thought that, in the enthusiasm of a supposed discovery, I claim too 
much ; time alone will decide this matter. 
?Such as our own hands, so far as they reach; the speculum,endoscope,bougies 
probes, forceps, palpation, etc. 2 
LITTLE PEOPLE AS AIDS, ETC. 
an additional means another weapon to combat ’the enemy. The 
procedure then that we suggest is but a modification of a method 
employed a few times on a larger scale, viz : the introduction of the 
hand and arm into the rectum and colon; hut instead of intro- 
ducing our large, unwieldy members, stretching and tearing as we 
go (and which is oftentimes from the small size of the intestines, an 
impossibility), we would employ a dwarf's or child’s hand and arm, 
or the atrophied or mutilated member of an adult, as an intelligent 
instrument or explorer, guided from the outside by the hands and 
directions of the physician. That there is but little difficulty in its 
application, and as little danger in general, will be evident to any 
one who has studied the size and relations of the rectum, its shape 
and attachments, as well as the size and loose attachments of the des- 
cending and transverse colon ; and that an intelligent child, dwarf, 
or small woman, guided by the physician, can do the work, I 
think few will doubt. It being a simple matter of touch, surely 
any one who possesses this sense can know and tell something of 
what he feels, 1st, as to its size; 2d, concerning its shape; 3d, 
about its properties, softness, hardness, etc.; 4th, as to its position ; 
5th, and, most important of all, its fixedness, mobility, etc., 
as ascertained by bringing the parts toward the integument, in 
order that the physician himself may feel, and certainly a rectal 
tube in a little hand can often be carried up as far as, and, 
if the arm be long enough, even into the transverse colon, and 
thus be slipped into the ascending portion of the same. With the 
arm and hand well in the gut, if the colon be loosely attached or 
very moveable, the various organs of the abdominal cavity may 
be explored and a very fair idea gained of their size, posi- 
tion, etc. Small fingers also can do good work for us in other 
cavities, such for instance as the pharangeal, when our own; the 
laryngscope and forceps cannot be used for the removal of for- 
eign bodies, etc.; and where it is desirable to pass a catheter* into 
the larynx for purposes of medication. There are other condi- 
tions under which this method can be employed that will readily 
occur to physicians. The paper was intended only to be suggestive, 
and is by no means exhaustive. In the practical employment of this 
*Tlie surgeon should try do, this himself, but in exceptional cases it is impos- 
sible, one of which I had, and would have been glad of the aid of a small person. LITTLE PEOPLE AS AIDS, ETC. 
3 
plan, we would choose dwarfs of spare build,* with little hands and 
arms; or the atrophied arm and hand of a deformed person,f or 
one who has lost part or all of the hand from surgical operation, 
and where these are not available, bright children from five to 
thirteen years of age, preferably such as have been instructed by 
the Kindergarten or object-lesson method, which enables them to 
describe with precision. After giving the patient an enema, so as 
to clear the rectum of foeces, we would place him in a convenient 
position, under chloroform, and take the oiled hand of the 
assistant, made as conical as possible, by the wrist, and force it 
gently through the sphincter, placing our other hand on the abdo- 
men, and directing the explorer to sweep round the cavity in every 
direction and describe what he feels. If the fingers and arm are 
benumbed by the sphincter, which is probably the last place 
to loose its sensibility and contractility under chloroform, 
a short three-bladed speculum may be introduced, and the 
hand passed through this. When we are not sure of the 
position of the lmnd in the bowels, it would be well to direct 
the explorer to point with the free member where it is, or 
to press outwardly toward the integument, which will generally 
be satisfactory. If obstructions occur in the passage, make the 
explorer turn his hand around them in every direction possible, to 
ascertain if they be free, and if so, direct their removal. The 
greatest difficulty will be experienced from the sigmoid flexure ; 
but by patient pressure, sweeping the hand in the various direc- 
tions required, it can generally be passed, or if not, pushed forward 
so as to show the nature of the interference, whether bands, tumors, 
etc. By a few well directed questions the explorer will tell you 
how things feel, and you can then draw more or less correct con- 
clusions. Avery timid child might not succeed, but a bold, truthful, 
obedient one would be invaluable; still more so would be a nurse 
with a small hand, who has been instructed in a large hospital as 
to the relations and feel of the internal organs of the cadaver; or 
a blind person, whose fingers have been educated in reading. The 
hand and arm once in the intestine, the intelligent physician 
will not fail to see how best to employ it, and with hand on 
* Dwarfs of spare build are, I know, rare, and their tactile sensibility occasionally 
impaired, bht women with small hands plentiful. 
tSorne of the devotees of India, if religious considerations do not preclude. 4 
LITTLE PEOPLE AS AIDS, ETC. 
the abdomen, direct its motions so as to acquire the desired infor- 
mation. That this means should not have been frequently em- 
ployed heretofore, or should be objected to now, except on the 
moral ground of unwillingness to use children, is probably due to 
a disinclination on the part of some to make any exploration of 
the rectum, as well as a distrust most medical men entertain for 
the medical statements of non-professional persons. That such a 
feeling can be carried too far, however, and will not equally be 
shared by the coming surgeon, is one of the reasons that has in- 
duced me to venture to bring this method before a practical body 
of our profession, and to hope they will not be slow, where suit- 
able persons are obtainable, to use it for their difficulties. Finally, 
in presenting this paper for your consideration, I do not wish to 
claim for it infallibility in discovering small lesions, or that it will 
do no harm when rashly employed ; but think that its judicious use 
under certain conditions will throw some light on many obscure 
and puzzling cases, and be the means, I hope, of saving lives.